Provider Demographics
NPI:1215548920
Name:VALTER, MARLENE WILVA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:WILVA
Last Name:VALTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25350 MAGIC MOUNTAIN PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1356
Mailing Address - Country:US
Mailing Address - Phone:805-813-3774
Mailing Address - Fax:
Practice Address - Street 1:25350 MAGIC MOUNTAIN PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-1356
Practice Address - Country:US
Practice Address - Phone:805-813-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical